Use of standardized body composition measurements and malnutrition screening tools to detect malnutrition risk and predict clinical outcomes in children with chronic conditions.

BACKGROUND Better tools are needed to diagnose and identify children at risk of clinical malnutrition. OBJECTIVES We aimed to compare body composition (BC) and malnutrition screening tools (MSTs) for detecting malnutrition on admission; and examine their ability to predict adverse clinical outcomes [increased length of stay (LOS) and complications] in complex pediatric patients. METHODS This was a prospective study in children 5-18 y old admitted to a tertiary pediatric hospital (n = 152). MSTs [Pediatric Yorkhill Malnutrition Score (PYMS), Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP), and Screening Tool for Risk of Impaired Nutritional Status and Growth (STRONGkids)] were completed on admission. Weight, height, and BC [fat mass (FM) and lean mass (LM) by DXA] were measured (n = 118). Anthropometry/BC and MSTs were compared with each other and with clinical outcomes. RESULTS Subjects were significantly shorter with low LM compared to reference data. Depending on the diagnostic criteria used, 3%-17% were classified as malnourished. Agreement between BC/anthropometric parameters and MSTs was poor. STAMP and STRONGkids identified children with low weight, LM, and height. PYMS, and to a lesser degree STRONGkids, identified children with increased LOS, as did LM compared with weight or height. Patients with complications had lower mean ± SD LM SD scores (-1.38 ± 1.03 compared with -0.74 ± 1.40, P < 0.05). In multivariable models, PYMS high risk and low LM were independent predictors of increased LOS (OR: 3.76; 95% CI: 1.36, 10.35 and OR: 3.69; 95% CI: 1.24, 10.98, respectively). BMI did not predict increased LOS or complications. CONCLUSIONS LM appears better than weight and height for predicting adverse clinical outcomes in this population. BMI was a poor diagnostic parameter. MSTs performed differently in associations to BC/anthropometry and clinical outcomes. PYMS and LM provided complementary information regarding LOS. Studies on specific patient populations may further clarify the use of these tools and measurements.

[1]  R. Shamir,et al.  Opinions and practices of healthcare professionals on assessment of disease associated malnutrition in children: Results from an international survey. , 2019, Clinical nutrition.

[2]  T. Cole,et al.  Body composition reference charts for UK infants and children aged 6 weeks to 5 years based on measurement of total body water by isotope dilution , 2019, European Journal of Clinical Nutrition.

[3]  H. Kruizenga,et al.  The new ESPEN diagnostic criteria for malnutrition predict overall survival in hospitalised patients. , 2016, Clinical nutrition.

[4]  M. Roelants,et al.  Proposal for An Algorithm for Screening for Undernutrition in Hospitalized Children , 2016, Journal of pediatric gastroenterology and nutrition.

[5]  Y. Vandenplas,et al.  Screening and assessment tools for pediatric malnutrition , 2016, Current opinion in clinical nutrition and metabolic care.

[6]  D. Heyland,et al.  Nutritional Status Based on Body Mass Index Is Associated With Morbidity and Mortality in Mechanically Ventilated Critically Ill Children in the PICU* , 2016, Critical care medicine.

[7]  B. Koletzko,et al.  Malnutrition risk in hospitalized children: use of 3 screening tools in a large European population. , 2016, The American journal of clinical nutrition.

[8]  P. Dey,et al.  Is undernutrition prognostic of infection complications in children undergoing surgery? A systematic review. , 2016, The Journal of hospital infection.

[9]  K. Lawson,et al.  Simple Nutrition Screening Tool for Pediatric Inpatients. , 2016, JPEN. Journal of parenteral and enteral nutrition.

[10]  J. Laffey,et al.  Effects and Mechanisms by Which Hypercapnic Acidosis Inhibits Sepsis-Induced Canonical Nuclear Factor-&kgr;B Signaling in the Lung , 2015, Critical care medicine.

[11]  S. Beer,et al.  Pediatric Malnutrition: Putting the New Definition and Standards Into Practice. , 2015, Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition.

[12]  F. Cools,et al.  Accuracy of Nutritional Screening Tools in Assessing the Risk of Undernutrition in Hospitalized Children , 2015, Journal of pediatric gastroenterology and nutrition.

[13]  N. Peretti,et al.  Incorrect evaluation of the frequency of malnutrition and of its screening in hospitalized children by health care professionals. , 2015, Journal of evaluation in clinical practice.

[14]  A. Gossum,et al.  Diagnostic criteria for malnutrition - An ESPEN Consensus Statement. , 2015, Clinical nutrition.

[15]  Berthold Koletzko,et al.  Disease associated malnutrition correlates with length of hospital stay in children. , 2015, Clinical nutrition.

[16]  S. Jebb,et al.  Skeletal muscle mass reference curves for children and adolescents , 2014, Pediatric obesity.

[17]  J. Pichler,et al.  Prevalence of undernutrition during hospitalisation in a children’s hospital: what happens during admission? , 2014, European Journal of Clinical Nutrition.

[18]  J. Hulst,et al.  Nutritional screening tools for hospitalized children: methodological considerations. , 2014, Clinical nutrition.

[19]  Y. Vandenplas,et al.  Hospital‐related undernutrition in children: still an often unrecognized and undertreated problem , 2013, Acta paediatrica.

[20]  W. Schwenk,et al.  Defining pediatric malnutrition: a paradigm shift toward etiology-related definitions. , 2013, JPEN. Journal of parenteral and enteral nutrition.

[21]  J. Wells,et al.  Use of Fat Mass and Fat Free Mass Standard Deviation Scores Obtained Using Simple Measurement Methods in Healthy Children and Patients: Comparison with the Reference 4-Component Model , 2013, PloS one.

[22]  M. Elia,et al.  Body composition by whole-body bioelectrical impedance and prediction of clinically relevant outcomes: overvalued or underused? , 2013, European Journal of Clinical Nutrition.

[23]  T. Cole,et al.  Body-composition reference data for simple and reference techniques and a 4-component model: a new UK reference child. , 2012, The American journal of clinical nutrition.

[24]  M. McHugh.  Interrater reliability: the kappa statistic , 2012, Biochemia medica.

[25]  H. McNulty,et al.  The development and evaluation of the Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP©) for use by healthcare staff. , 2012, Journal of human nutrition and dietetics : the official journal of the British Dietetic Association.

[26]  B. Koletzko,et al.  Malnutrition screening tools for hospitalized children , 2012, Current opinion in clinical nutrition and metabolic care.

[27]  R. Burgos,et al.  Prevalence of malnutrition and its etiological factors in hospitals. , 2012, Nutricion hospitalaria.

[28]  Fernanda de Souza Menezes,et al.  Malnutrition as an independent predictor of clinical outcome in critically ill children. , 2012, Nutrition.

[29]  B. Harrison,et al.  Prevalence of malnutrition and risk of under-nutrition in hospitalized children. , 2012, Clinical nutrition.

[30]  J. Hulst,et al.  Malnutrition in pediatric hospital patients: current issues. , 2011, Nutrition.

[31]  T. Kotsimbos,et al.  Fat-free mass depletion in cystic fibrosis: associated with lung disease severity but poorly detected by body mass index. , 2010, Nutrition.

[32]  P. Sullivan.  Malnutrition in hospitalised children , 2010, Archives of Disease in Childhood.

[33]  L. R. Susin,et al.  Body weight and fat-free mass changes in a cohort of patients receiving chemotherapy , 2010, Supportive Care in Cancer.

[34]  K. Gerasimidis,et al.  A four-stage evaluation of the Paediatric Yorkhill Malnutrition Score in a tertiary paediatric hospital and a district general hospital , 2010, British Journal of Nutrition.

[35]  R. Halfens,et al.  Defining malnutrition: mission or mission impossible? , 2010, Nutrition.

[36]  W. Hop,et al.  Dutch national survey to test the STRONGkids nutritional risk screening tool in hospitalized children. , 2010, Clinical nutrition.

[37]  C. R. M. D. M. Chaves,et al.  Association between nutritional status measurements and pulmonary function in children and adolescents with cystic fibrosis. , 2009, Jornal brasileiro de pneumologia : publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia.

[38]  J. Hulst,et al.  Prevalence of malnutrition in pediatric hospital patients , 2008, Current opinion in pediatrics.

[39]  T. Amaral,et al.  The economic impact of disease-related malnutrition at hospital admission. , 2007, Clinical nutrition.

[40]  J. Wells,et al.  Is body composition important for paediatricians? , 2007, Archives of Disease in Childhood.

[41]  J. Carlin,et al.  Association of body composition and lung function in children with cystic fibrosis , 2005, Pediatric pulmonology.

[42]  M. Elia,et al.  ESPEN guidelines for nutrition screening 2002. , 2003, Clinical nutrition.

[43]  A. Bosy-Westphal,et al.  Metabolically active components of fat‐free mass and resting energy expenditure in humans: recent lessons from imaging technologies , 2002, Obesity reviews : an official journal of the International Association for the Study of Obesity.

[44]  J. Reilly,et al.  Malnutrition in a children's hospital , 1997 .

[45]  T J Cole,et al.  Body mass index reference curves for the UK, 1990. , 1995, Archives of disease in childhood.

[46]  T J Cole,et al.  Cross sectional stature and weight reference curves for the UK, 1990. , 1995, Archives of disease in childhood.

[47]  Jane V. White,et al.  Consensus statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition: indicators recommended for the identification and documentation of pediatric malnutrition (undernutrition). , 2014, Journal of the Academy of Nutrition and Dietetics.

[48]  A. Castañeda,et al.  The effect of preoperative nutritional status on postoperative outcomes in children undergoing surgery for congenital heart defects in San Francisco (UCSF) and Guatemala City (UNICAR). , 2014, The Journal of thoracic and cardiovascular surgery.

[49]  G. Wanten,et al.  [Paediatric screening for malnutrition still in its infancy]. , 2010, Nederlandsch tijdschrift voor geneeskunde.

[50]  K. Michaelsen,et al.  The need for nutrition support teams in pediatric units: a commentary by the ESPGHAN committee on nutrition. , 2005, Journal of pediatric gastroenterology and nutrition.

[51]  C. Patch,et al.  Implementation of malnutrition screening and assessment by dietitians: malnutrition exists in acute and rehabilitation settings , 2001 .